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APPLICATION FOR ELECTRICAL ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE,.COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING, LOCALITY 7-E,*-1'7
NEAREST
FOR APPLICANT TO FILL IN CROSS ST, j� p
RECEPT. TOTAL NO. EACH FEE
11 OUTLETS
T I FIST 20 $ $
LIGHT 20
OMAIL
ADD'L ADDNR
EESRS p �
SWIOVER 20 10
TOTAL FIRST 201 .20 CITY - TEL. NO.
LIGHTING I
FIXTURES
FIXTURES ADD'L OVER 20 •10 CONTRACTOR
RANGES DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DISP. STA.COOK
CITY 'TEL.NO.
DISHWASH. AUTO.-WASH. STATE �t
SPACE HTRS. STA. APP L. .50
LICENSE NO. l f 4 J �d
MOTORS: OVER NOT OVER H.P. DISTRICT Np I GROUP ZONE PROCE BY
O 1 1.00 Q
1 3 1.50 INSPECTION RECORD °-
O
3 s 2.00
U
a
/ /� /
8 15 2.50 ! / C!j' /' �,,,/ O
15 50 3.00 / rd "'. a�-`""�pUJ
ex
50 100 5.00 cn
SIGNS: NO.TRANS
NO.LAMPS
SERVICE 0-60OV-NOT OVER 200A 1.00
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
�Q1' O' 6
PIZ -67
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TOTAL FEE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING )
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES '✓
LICENSED AS REQUIRED BY LOS ANGEL ��g ATE OF
CALIFORNIA O TH I All EE END TO POWER
RESIDE 1 IB RE J
oll
SIGNAT UTILITY CO.NOTIFIED I
OF PER f
FINAL
I IDATION JOSEPH C. ROOHAN
ELECTRICAL
SUPERVISING ELECTRICAL ENGINEER
CK MO .CASH